摘要:

Various recording methods were tested in 60 patients who underwent scoliosis surgery to find the most suitable technique for the spinal cord monitoring and to elucidate the neuroanatomic relationship of the evoked potentials recorded by these methods. Responses were recorded from the scalp and spine after stimulation of the tibial nerve or the spinal cord. The potentials from electrodes placed over the muscles and the tibial nerve after stimulation of the spinal cord were also recorded. Epidurally recorded spinal evoked potentials after stimulation of the tibial nerve generally consisted of two major negative peaks, NI and NII, and subsequent multiple waves. NI may be mediated through the spinocerebellar tract, and NII is most likely mediated through the dorsal column. The polyphasic waves are probably conducted through the slower sensory ascending pathways. The potentials recorded from the muscle after spinal cord stimulation may be mediated through the motor tract. Various recording techniques described in this study were mutually complimentary in comfirming the results of tests recorded in the technically difficult environment of the operating room. In general, spinal cord stimulation recorded from the scalp or the spine was superior to peripheral nerve stimulation in yielding better defined responses. If the potential recorded from the muscle after stimulation of the spinal cord is indeed mediated through the motor pathway, this would be useful to assess motor function during surgery.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Between 1963 and 1971, Harrington's technique was used by the senior author to operate on 493 scoliotic patients, of which 364 were idiopathic. A total of 276 patients were re-examined, of which 209 were idiopathic cases. All met the following criteria: (1) a follow-up period of at least 10 years; (2) the operation was performed by the same surgeon; and (3) the review was undertaken by one person. The average follow-up period was 13 years, 10 months. A total of 95 patients had a follow-up period of more than 15 years, of these 75 patients were idiopathic. The surgical technique was similar in all cases: a distraction rod in the concavity, arthrodesis by decortication, and a corticospongious graft obtained from one or both iliac crests. Postoperative immobilization was assured by a plaster corset for 6 months, followed by a “plexidur corset lyonnais.” The review of the patients examined was based on rigorous clinical and radiological analyses. Anteroposterior and lateral radiographs were obtained, complemented by a lateral radiograph of the lumbosacral segment. The angular results were disappointing, decreasing from 66.2° to 38° immediately postoperatively but increasing to an average final curve of 51.4°. Clinical results were good: Only 21.3% of patients actually had back pain. The patients were satisfied with their appearance and their professional, social, and marital status. This study indicates the outcome of the lumbar spine below the graft. The vertebral bodies were modified morphologically; they became elongated and more trapezoidal leading to a quite normal average lordosis. A short kyphosis occurred when the lower hook rested on T12, L1, or L2. The authors thought that the best rest-level was L3 or L4. Low-back pain was not increased with this low rest-level.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

In an attempt to find prognostic factors for mild scoliosis, the first clinical and radiologic data of 159 subjects with idiopathic scoliosis less than 30° were correlated with the annual speed of progression estimated graphically by further examinations. Thoracic and double major are more progressive than thoracolumbar and lumbar. The correlation with rate of progression is better for supine angle than for standing angle. Curves with low supine angles are those that have great relative collapse and low risk of progression. Only the rib hump of thoracic and thoracolumbar are correlated with evolutivity. Predictive equations give less approximation for individual prognosis than a previous graphic method, so they are not used. Approximately 73% of scoliosis have evolutivities less than 6° per year and required nocturn corrective treatment.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The standing Cobb measure in a group of 287 girls with idiopathic scoliosis at the start of treatment was in the mean approximately 9° larger than the supine Cobb measure. This mean standing-supine difference was essentially independent of curve severity expressed by the supine Cobb measure. Because of this, when the difference was expressed as a percentage of the supine Cobb measure, the mean values of this ratio decreased substantially with increasing curve severity. The mean difference decreased only slightly with age through adolescence, indicating that spine lateral curves stiffen little as patients mature. The standard deviations in the standing minus supine Cobb differences were approximately 6° in the majority of the age and severity groupings studied. Ninety-three percent of these patients had standing-supine Cobb measure differences that were between 0° and 20°.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

This work is a critical analysis of the term “flexibility of scoliosis.” The authors demonstrate that this measure includes two very different and noncorrelated phenomena: the collapse and the reducibility of the structural curve. In 228 paralytic curves, these two phenomena were quantified and correlated with different parameters of scoliosis: sex, stage of maturation, curve pattern, number of vertebrae in the curve, spinal and abdominal test values, and the scoliotic evolution rate. Reducibility can be predicted since it is an elasticity process. Collapse is more complex, but it is a prognostic factor for evolution and effectiveness of treatment. The preliminary results of a similar study of idiopathic scoliosis are the same.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

A study of standing, supported-standing (“riding” on a rounded seat), and sitting postures was carried out on persons simulating assembly work in places with poor leg space. These postures and the upper trapezius muscle load were examined using statometric and electromyographic methods, respectively. While supported-standing or sitting, the lumbar spine moved toward kyphosis, even where there was no backward rotation of the pelvis. In adopting the position for anteriorly placed work, the upper arms were raised 30° forward or more; then, if a greater reach was necessary, the trunk was flexed as well. It is concluded that if leg space is poor, variation between supported-standing and standing should be encouraged, and an ordinary office chair avoided. Working level should be arranged so that it is lower than 5 cm above elbow level if no arm/wrist support is possible.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The relationship between pain modifying factors, pain duration, and the role of anxiety in low-back pain experience were studied. Three groups of patients with low-back pain were examined using the Tourniquet Pain Test, McGill Pain Questionnaire, Rating Scale of Pain Intensity, State-Trait Anxiety Inventory, and Psychological Discomfort Questionnaire. Significant differences in all measured features emerged between acute and chronic pain groups. Groups of acute and subchronic pain and groups of subchronic and chronic pain differed only in several parameters, suggesting an intermittent phase in acute pain transition into chronicity. While pain prolonged, pain experience gradually but irregularly changed, exaggerating pain perception. The changes concerned mainly emotional factors and were related to the chronicity itself. Anxiety also played a significant role.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

X-ray findings in the thoracic and lumbar spine from 666 60-year-old men and women from a general population were related to anamnestic data and physical measurements. Disc degenerations were significantly more common among those with low-back pain (LBP) compared with those without. The corresponding calculated predictive values stressed the importance of taking precaution in interpreting the radiologic findings in the clinical situation. In several instances, there were significantly more positive (abnormal) radiologic findings among those with the heaviest work. Disc degeneration and scoliosis were particularly frequent in this regard. Absolute weight and body mass index was significantly higher in persons with spondylosis. The fingertip-floor distance was greater with higher frequency of spondylosis and L4 disc degeneration.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

A method for the measurement of intervertebral disc heights from lateral radiographs obtained in controlled conditions was examined for intra- and interobserver errors. The use of a strict criterion for the positioning of marks on the images of the vertebrae was shown to enable reproducible measurements to be made with a maximum error of 0.7 mm. Measurements of anterior and posterior disc heights and disc depths were made for 11 normal subjects and ten male patients with prolapsed intervertebral discs, while standing upright. The level of the prolapsed discs were shown to have reduced height compared with normal before surgery, and further narrowing 3 months after surgery. The unaffected discs of the patients were the same height as those of the controls. The technique is proposed as suitable for the investigation of the effect on intervertebral discs of procedures such as the injection of chymopapain.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The significance of alteration of lumbar spinal motion in cases of herniated disc was examined using a threedimensional x-ray technique (biplanar radiography) before and 3 months after discectomy. Fifteen consecutive cases of disc herniation were studied prospectively. Predictions of clinical examination, myelography, and motion study for the level and site of the lesion were correlated with the operative findings for their accuracy in localization of the lesion. Changes in lumbar spinal motion after surgery were also correlated with the clinical results. The clinical and myelographic predictions were similar to previously published studies. The present study showed that patients with a sequestrated or prolapsed disc lesion (as opposed to bulging disc) had an abnormally large lateral bend or axial rotation during flexion and extension at the level above, which reduced after surgery. Primary lumbar spinal motions (flexion and extension) were generally reduced to half of the normal value and were not significantly altered by surgery. The restriction of lumbar spinal motion was not significantly reflected in the clinical results, which were satisfactory in most cases. Discectomy by fenestration and minimal resection of the lamina did not produce instability.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID